scholarly journals Psychiatric staff training in managing medical emergencies: re-audit

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S63-S63
Author(s):  
Sarah Abd El Sayed ◽  
Sudhir Salujha
Keyword(s):  
Physical Health ◽  
Nursing Staff ◽  
Life Support ◽  
Psychiatric Inpatient ◽  
Inpatient Setting ◽  
Local Hospital ◽  
Staff Members ◽  
Psychiatric Units ◽  
Psychiatric Staff ◽  
Level Of Training

AimsIn the UK, people with severe mental illness at a greater risk of poor physical health and have higher premature mortality than the general population, highlighting the importance of responding to physical health problems among patients suffering from psychiatric conditions. However, training for staff on inpatient psychiatric units to meet patients’ physical health needs is sometimes overlooked and has not always been effective.According to NICE Clinical Guideline 25 (2005) and NPSA Rapid Response Report (2008/RRR010), staff on any psychiatric inpatient setting must be capable of monitoring, measurement, and interpretation of vital signs. They must have both adequate information and skills to identify signs indicating worsening of patients’ health and respond effectively to severely ill patients.Hence, we aim to re-audit the results of a similar audit carried out in 2016 to review the level of medical emergency training (in terms of life support training) of clinical staff across the inpatient psychiatric wards at our local hospital - Stepping Hill Hospital- in Stockport.Our hypothesis is that there will be a gap in meeting the required standards for training.MethodA questionnaire including 6 questions (role of the staff member, level of their life support training, when was their training last updated, whether they know the location of the crash trolley, whether they know the local hospital emergency number and whether they should resuscitate the patient if their training is out of date) was given to staff on acute inpatient psychiatric units in Stepping Hill Hospital.ResultThe sample included 49 staff members from all the 3 wards included in the audit. The level of training of nursing staff on the 3 wards was meeting standards except for nursing staff who were new to the wards or coming back to work from prolonged leaves. There was also a gap identified in the level of training of other staff members on the ward as well as on the remaining standards measured by the audit.ConclusionA gap was identified in meeting the required standards of training on the inpatient psychiatric units. Reasons identified for this gap are mainly due to the fact that new or bank staff are asked to cover the wards without providing them with appropriate training and without orientating them about the location of different equipments and policies on the ward.

Violent incidents within psychiatric settings

2017 ◽  
Vol 41 (S1) ◽  
pp. S589-S589
Author(s):  
B. Motamedi ◽  
A. Mahmoudi ◽  
M. Motamedi
Keyword(s):  
Relative Risk ◽  
Nursing Staff ◽  
Violent Behavior ◽  
Psychiatric Inpatient ◽  
Low Grade ◽  
Psychiatric Units ◽  
Inpatient Settings ◽  
Competing Interest ◽  
Complex Relationships ◽  
Patient Mix

ObjectiveTo determine the frequency and types of aggressive and violent behaviors in acute psychiatric inpatient settings and potential interactions between staffing and patient mix and rates of the behaviours were explored.MethodsData on violent incidents were gathered prospectively in two acute psychiatric units in two general hospitals and two units in a psychiatric hospital in Isfahan, Iran. Staff recorded violent and aggressive incidents by using Morrison's hierarchy of aggressive and violent behavior. The classification ranged from level 1, inflicted serious harm to self or others requiring medical care, to level 8, exhibited low-grade hostility. They also completed weekly reports of staffing levels and patient mix. Regression analysis was used to calculate relative rates.ResultsA total of 400 violent incidents were recorded over a three-month period. Based on the scale, more than 50 percent of the incidents were serious. Seventy-eight percent were directed toward nursing staff. Complex relationships between staffing, patient mix, and violence were found. Relative risk increased with more nursing staff (of either sex), more non nursing staff on planned leave, more patients known to instigate violence, a greater number of disoriented patients, more patients detained compulsorily, and more use of seclusion. The relative risk decreased with more young staff (under 30 years old), more nursing staff with unplanned absenteeism, more admissions, and more patients with substance abuse or physical illness.ConclusionsViolent incidents within psychiatric facilities were frequent and serious, with great significance for occupational health. Some clues were found in the prediction of violence.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychological and the physical health impacts of forensic workplace trauma

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Dipti Mistry ◽  
Lynsey Gozna ◽  
Tony Cassidy
Keyword(s):  
Physical Health ◽  
Health Effects ◽  
Nursing Staff ◽  
Hospital Setting ◽  
Well Being ◽  
Potential Health ◽  
Content Type ◽  
Staff Members ◽  
Workplace Trauma

Purpose Health-care professionals working in inpatient forensic mental health settings are exposed to a range of traumatic and distressing incidents with impacts discussed variously as “burnout”, “compassion fatigue”, “secondary trauma stress” and “vicarious traumatisation”. This study aims to explore the short- and long-term psychological and physical health effects of trauma exposure in the workplace for frontline staff in a forensic setting. Design/methodology/approach Semi-structured interviews were conducted with 14 nursing staff members working in the male personality disorders care stream in a Medium Secure Hospital. Findings Thematic analysis yielded five themes: categories of trauma; how well-being is impacted; ways of coping and managing; protective factors; and systemic factors, with sub-themes within each of the superordinate themes. Practical implications The findings demonstrate that some staff members were affected both physically and psychologically as a result of trauma-focused work whereas other staff members were unaffected. The psychological and physical health effects were broadly short-term; however, long-term effects on staff member’s social networks and desensitisation to working conditions were observed. A broad range of coping methods were identified that supported staff member’s well-being, which included both individual and organisational factors. Staff member’s health is impacted by exposure to workplace trauma either directly or indirectly through exposure to material, and there is a greater need to support staff members after routine organisational provisions are complete. Staff should receive education and training on the possible health effects associated with exposure to potentially traumatic material and events. Originality/value This research has further contributed to understanding the staff needs of nursing staff members working with the forensic personality disorder patients within a secure hospital setting. This research has identified the following service developments: the need for ongoing support particularly after organisational provisions are complete; further prospects to engage in psychological formulations; greater opportunities for informal supervision forums; staff training to understand the potential health impact associated with trauma-focused work; supervisors being appropriately trained and supported to elicit impacts of trauma-focused work on staff members; and additional opportunities to discuss well-being or monitor well-being.

The Milieu Manager: A Nursing Staffing Strategy to Reduce Observer Use in the Acute Psychiatric Inpatient Setting

2017 ◽  
Vol 23 (6) ◽  
pp. 422-430 ◽  
Author(s):  
Patrick Triplett ◽  
Sandra Dearholt ◽  
Mary Cooper ◽  
John Herzke ◽  
Erin Johnson ◽  
...  
Keyword(s):  
Patient Safety ◽  
Medical Center ◽  
Academic Medical Center ◽  
Psychiatric Inpatient ◽  
Cost Effective ◽  
Cost Of Care ◽  
Inpatient Setting ◽  
Patient Acuity ◽  
Psychiatric Units ◽  
Nursing Cost

BACKGROUND: Rising acuity levels in inpatient settings have led to growing reliance on observers and increased the cost of care. OBJECTIVES: Minimizing use of observers, maintaining quality and safety of care, and improving bed access, without increasing cost. DESIGN: Nursing staff on two inpatient psychiatric units at an academic medical center pilot-tested the use of a “milieu manager” to address rising patient acuity and growing reliance on observers. Nursing cost, occupancy, discharge volume, unit closures, observer expense, and incremental nursing costs were tracked. Staff satisfaction and reported patient behavioral/safety events were assessed. RESULTS: The pilot initiatives ran for 8 months. Unit/bed closures fell to zero on both units. Occupancy, patient days, and discharges increased. Incremental nursing cost was offset by reduction in observer expense and by revenue from increases in occupancy and patient days. Staff work satisfaction improved and measures of patient safety were unchanged. CONCLUSIONS: The intervention was effective in reducing observation expense and improved occupancy and patient days while maintaining patient safety, representing a cost-effective and safe approach for management of acuity on inpatient psychiatric units.

Cardiovascular risk assessment in psychiatric inpatient setting

2016 ◽  
Vol 33 (S1) ◽  
pp. s281-s281
Author(s):  
E. Dahmer ◽  
N.C. Lokunarangoda ◽  
K. Romain ◽  
M. Kumar
Keyword(s):  
Cardiovascular Risk ◽  
Psychiatric Inpatient ◽  
Cardiac Risk ◽  
Inpatient Setting ◽  
Qtc Interval ◽  
Cardiac Health ◽  
Psychiatric Units ◽  
Acute Psychiatric Wards ◽  
Competing Interest ◽  
Clinically Significant

ObjectivesTo assess the general cardiac health of inpatients in acute psychiatric units and to evaluate the practice of ECG use in this setting.AimsOverall cardiac risk is assessed using QRISK2. Clinically significant ECG abnormality detection by psychiatric teams are compared with same by cardiologist.MethodsTen percent of patients (n = 113) admitted to five acute psychiatric wards during a period of 13 months across three hospital sites, covering a population of 1.1 million, were randomly selected. Electronic health care records were used to collect all data, in the form of typed entries and scanned notes. An experienced cardiologist, blind to the psychiatrist assessments, performed ECG analysis. The QRISK2 online calculator was used to calculate 10-year cardiovascular risk as recommended by NIHR, UK.ResultsA score of 10% or more indicates a need for further intervention to lower risk.13.5% of patients had a QRISK2 score of 10–20%, 5.2% had a score of 20–30%, and 1 patient had a QRISK2 score > 30%. In total, 19.7% had a QRISK2 of 10% or greater. A total of 2.9% had prolonged QTC interval (> 440 ms), with 2.9% having a borderline QTC (421–440). A total of 34.3% of ECGs were identified by the ward doctors as abnormal, with action being taken on 41.6% of these abnormal ECGs. Cardiologist analysis identified 57.1% of ECGs with abnormalities of potential clinical significance.ConclusionsOne in five patients admitted to psychiatry wards have poor cardiac health requiring interventions. Though QTC interval prolongation is rare, half of patients may have abnormal ECGs that require further analysis.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Auditing improvements to physical health in the acute psychiatric inpatient setting

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S103-S104
Author(s):  
Joshua A. Silverblatt ◽  
Risha Ruparelia ◽  
Ayotunde Shodunke
Keyword(s):  
Physical Health ◽  
Structural Changes ◽  
Ad Hoc ◽  
Psychiatric Inpatient ◽  
Health Clinic ◽  
Inpatient Setting ◽  
Completion Rates ◽  
Health Issues ◽  
Post Intervention ◽  
Physical Health Outcome

AimsWhilst patient psychiatric health is the primary focus in the acute psychiatric inpatient setting, there has been a recent focus on ensuring a greater integration with physical health to address the physical health outcome inequalities between patients with psychiatric conditions and those without. Despite the ward having a robust physical health clerking proforma, there were issues with its completion; at initial clerking patients often aren't able, or refuse, to consent to physical examination or investigations. This lead to the trust's electronic physical health form, designed to collate these results, not always being completed. Our aim was to increase the rates of completion.MethodChanges to ward handover sheets were made in an effort to increase rates of physical health form completion and improve 24 and 72 hour completion rates. Columns were added delineating which parts of the physical clerking were outstanding, ensuring the MDT were aware of which jobs needed actioning. Data for two months prior and post intervention were analysed.Result266 admissions were analysed for the two months prior and post the intervention. Form completion rose from July (88%) to October (100%), with 24 and 72 hour completion rate increasing from 47% & 55% respectively, to 84% & 96%, during the same time period. Greater completion rates of physical health forms led to increased knowledge of patients’ physical health issues. Having 96% of patients physical health issues within three days of admission (cf. 55%, July), led to a 'physical health huddle' being held during the MDT. This provided a platform to discuss relevant physical health treatment plans with the whole team. These findings were summarised under a new column on the handover sheet and updated biweekly during the MDT meeting. Placement on the handover sheet ensured daily visibility to all staff.ConclusionSimple structural changes can bring physical health to the fore in psychiatric care. Timely and more complete physical health data enabled biweekly reviews of physical health issues and allowed input across the MDT. Increased knowledge and awareness of physical health issues led to an increase in medical review requests. These are currently performed on an ad hoc basis, which can be quite disorganised and inefficient. The results above, of improved physical health outcomes based on a structured approach, have led to a recommendation of a biweekly physical health clinic, with specific staffing allocation, to ensure a more thorough and efficient way to address physical health.

scholarly journals Potential drug-drug interactions in the psychiatric hospital: Frequency analysis

2019 ◽  
Vol 5 (4) ◽  
pp. 1-6
Author(s):  
Oleg O. Kirilochev ◽  
Inna P. Dorfman ◽  
Adelya R. Umerova ◽  
Svetlana E. Bataeva
Keyword(s):  
Drug Interactions ◽  
Clinical Significance ◽  
Psychiatric Hospital ◽  
Psychiatric Inpatient ◽  
Clinical Problem ◽  
Drug Combinations ◽  
Drug Prescriptions ◽  
Inpatient Setting ◽  
Potential Drug ◽  
Important Clinical Problem

Introduction: Drug-drug interactions are an important clinical problem in pharmacotherapy. This study is focused on different types of drugs used in a psychiatric hospital. Materials and methods: The pharmacoepidemiological study included the analysis of medical records of 500 psychiatric inpatients. The patients were divided into 2 groups: under 65 and over 65 years of age. All the drug prescriptions were analyzed to identify the combinations of drugs that can induce drug-drug interactions and determine their clinical significance. Results and discussion: Over 77% of hospitalized patients were administered drug combinations that could induce drug-drug interactions, most of which were of moderate clinical significance. A reliable association was found between the patient’s age, the clinical significance of drug-drug interactions, and the pharmacotherapy structure. The most common irrational drug combinations were identified. Conclusion: Timely analysis of drug prescriptions for potential drug-drug interactions can enhance the safety of pharmacotherapy and decrease the risk of adverse drug reactions in the psychiatric inpatient setting.

scholarly journals Ethical climate in a Belgian psychiatric inpatient setting: relation with burnout and engagement in psychiatric nurses

2013 ◽  
Vol 1 (2) ◽  
pp. 443
Author(s):  
Astrid Faelens ◽  
Marleen Claeys ◽  
Bernard Sabbe ◽  
Didier Schrijvers ◽  
Patrick Luyten
Keyword(s):  
Job Satisfaction ◽  
Turnover Intention ◽  
Ethical Climate ◽  
Ethical Issues ◽  
Psychiatric Inpatient ◽  
Psychiatric Nurses ◽  
Inpatient Setting ◽  
Cross Sectional ◽  
Emotional Burden ◽  
The Relationship

Research suggests a relation between the ethical climate – that is, the organisational conditions and practices that affect the way ethical issues with regard to patient care are discussed and decided - and job satisfaction of nurses. Yet no study to date has investigated the relationship between ethical climate and job satisfaction in psychiatric nurses. This study aimed to address this critical gap in our knowledge by investigating the relationships among ethical climate and features of both burnout and engagement based on the Job Demands-Resources Model (JD - R model) in a large cross-sectional study of 265 nurses working in a large psychiatric inpatient hospital in Flanders, Belgium. Correlational and multiple hierarchical regression analyses were used to investigate the relationship between ethical climate, burnout and engagement. In addition, based on the JD-R model, we also investigated whether engagement mediated the relationship between ethical climate on the one hand and job satisfaction and turnover intention on the other and whether ethical climate moderated the relationship between emotional burden and burnout. Results showed that a positive ethical climate was related to lower levels of emotional exhaustion and distancing and higher levels of engagement and job satisfaction. Furthermore, although ethical climate did not buffer against the effects of emotional burden on burnout, higher levels of engagement explained in part the relationship between ethical climate and job satisfaction.

Self-scheduling and staff incentives: meeting patient care needs in a neonatal intensive care unit

2001 ◽  
Vol 21 (4) ◽  
pp. 52-59 ◽  
Author(s):  
E Vetter ◽  
LD Felice ◽  
GL Ingersoll
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nursing Staff ◽  
Neonatal Intensive Care ◽  
Nurse Manager ◽  
The Self ◽  
Care Needs ◽  
New Employees ◽  
Staff Members ◽  
Innovative Process

Nursing staff and leadership in a resource-intensive NICU identified an innovative process for covering the unit's scheduling needs. Early concerns about the feasibility of achieving self-scheduling with a large staff were unwarranted. The use of a unit-based committee and the support of the nurse manager allowed us to develop a process that met the needs of the staff members and maintained the staffing standards of the unit. Contributing to the success of the self-scheduling is a mechanism for recognizing and rewarding staff members who adjust their work schedules to meet the needs of the unit. Satisfaction among staff members with self-scheduling is high, and new employees cite the opportunity for self-scheduling as a contributing factor in their decisions to work in the NICU.

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